Article excerpt

People who endure the I.C.U. are susceptible to horrible post-
traumatic stress.

When Lygia Dunsworth was sedated, intubated and strapped down in
the intensive care unit at a Fort Worth hospital, she was wracked by
paranoid hallucinations: Outside her window, she saw helicopters
evacuating patients from an impending tornado, leaving her behind.
Nurses plotted to toss her into rough lake waters. She hallucinated
an escape from the I.C.U. -- she ducked into a food freezer, only to
find herself surrounded by amputated body parts.

Mrs. Dunsworth, who had been gravely ill from abdominal
infections and surgeries, eventually recovered physically. But for
several years, her stay in intensive care tormented her. She had
short-term memory loss and difficulty sleeping. She would not go
into the ocean or a lake, and was terrified to fly, even to get into
a car and travel alone.

Nor would she talk about it. "Either people think you're crazy or
you scare them," said Mrs. Dunsworth, 54, a registered nurse. In
fact, she was having symptoms associated with post-traumatic stress
disorder.

About five million patients stay in an I.C.U. in the United
States each year. Studies show that up to 35 percent may have
significant symptoms of PTSD for as long as two years after that
experience, particularly if they had a prolonged stay due to a
critical illness with severe infection or respiratory failure. Those
persistent symptoms include intrusive thoughts, avoidant behaviors,
irritability and mood swings, emotional numbness, and reckless or
destructive behavior.

Yet I.C.U.-induced PTSD has been largely unidentified and
untreated. When patients leave the I.C.U., said O. Joseph Bienvenu,
a psychiatrist and associate professor at Johns Hopkins University
School of Medicine, "Everyone pays attention to whether patients can
walk and how weak they are. But it's the exception for them to be
screened for psychiatric symptoms like post-traumatic stress or low
mood."

Now critical care specialists are trying to prevent or shorten
the duration of the mood disorders, which can rattle not only I.C.U.
patients but their frantic relatives. Sometimes family members,
rather than the sedated patient, develop the symptoms of having been
traumatized, tormented by harrowing memories of a loved one
thrashing in restraints, delirious, near death.

Other PTSD sufferers -- victims of combat, sexual assault or
natural disasters -- endure flashbacks, but theirs are grounded in
episodes that can often be corroborated. What is unsettling for post-
I.C.U. patients is that no one can verify their horrors; one patient
described a food cart in the I.C.U., its vendor selling strips of
her flayed flesh.

"I.C.U. patients have vivid memories of events that objectively
didn't occur," Dr. Bienvenu said. "They recall being raped and
tortured as opposed to what really happened," such as painful
procedures like the insertion of catheters and intravenous lines.

The I.C.U. setting itself can feel sinister. The eerie, sleep-
indifferent lights. The cacophony of machines and alarms. Certain
treatments in the I.C.U. may be grim, but they are essential for
survival. Intubation, for example: Patients who need help breathing
must have a plastic tube placed down their windpipes for mechanical
ventilation. The feeling of near-suffocation and the inability to
speak can be nightmarish. Studies show that experiencing such
invasive procedures raises the odds that a patient may develop PTSD.

A longer stay in the I.C.U. also increases the risk of post-
traumatic symptoms. But some patients arrive more vulnerable to
PTSD. Women may be more at risk than men, as are patients with a
history of depression or other emotional difficulties. Because
patients often arrive in the I.C.U. unexpectedly, doctors do not
have the opportunity to take a psychological history and rarely
foresee the possibility of PTSD.

Age may be a factor. Elderly patients generally recover more
slowly, but younger patients may be more likely to develop symptoms
of PTSD. …